P1686: LONG-TERM COMORBIDITY AND HEALTH PROBLEMS IN ACUTE MYELOID LEUKEMIA (AML) SURVIVORS: AN INTERNATIONAL AML SURVIVORSHIP STUDY
Authors: Fabio Efficace, Laura Cannella, Xavier Thomas, Meltem Kurt Yüksel, Silvia Maria Trisolini, Alberto Brini, Ernesta Audisio, Luca Maurillo, Roberto M. Lemoli, Annalisa Imovilli, Irina Panovska-Stavridis, Livio Pagano, Maria Ciccone, Nunzio Filardi, Nicola Stefano Fracchiolla, Daniele Vallisa, Monica Crugnola, Nicola Cascavilla, Matevz Skerget, Marco Vignetti, Frederic Baron
Journal: HemaSphere (2023)

Topic: 35. Quality of life and palliative care Background: Owing to advances made in the treatment of acute myeloid leukemia (AML), for example with regard to transplantation strategies, the number of AML survivors has increased over the last decades. Therefore, it becomes increasingly important to understand the long-term effects of AML therapies to better address unmet needs of these patients. Aims: An international AML survivorship project was performed by the GIMEMA in collaboration with the EORTC Leukemia and Quality of Life Group, and we herein report first results of this project by describing the prevalence of long-term health problems and comorbidities experienced by these patients, overall and by age at diagnosis. Methods: Eligibility criteria of this international study by the GIMEMA and EORTC Leukemia and Quality of Life Groups included: a diagnosis of AML (at least 20% blast in bone marrow) other than acute promyelocytic leukemia, age ≥ 18 years, at least 5 years after diagnosis, and being in AML-free status at the time of study entry. Patients were approached at the hospital or by mail and those consenting were asked to complete a Survey Booklet, which also included a comprehensive list of health problems and comorbidities derived from the validated Self-administered Comorbidity Questionnaire and health problems from other AML survivorship studies. Comorbidity burden was defined as having at least one comorbidity/health problem vs none. The comorbidity burden, as well as each comorbidity prevalence was examined overall and stratified by median age at diagnosis, identifying two groups (younger and older AML survivors). Results: Between May 2019 and February 2022, 225 AML survivors were enrolled by 24 centers across 6 countries. There were 106 (47.1%) males and 119 (52.9%) females and the median age at diagnosis was 48.3 years. Almost half of patients had an intermediate education level (i.e. up to high school) (102, 45.3%) and the majority of participants were living with a partner (187, 83.1%). Median time from AML diagnosis was 8.8 years (IQR 6.4-11.9). There were 70 survivors (31.1%) who were treated in the setting of a randomized controlled trial during primary treatment. Time from AML diagnosis, and from end of treatment to study inclusion, were significantly longer (p<0.001) in younger survivors (median age at study inclusion of 46.8 years), compared to older survivors (median age at study inclusion of 66.8 years). Similar frequencies of at least one AML relapse and allogeneic hematopoietic stem cell transplantation were observed in younger and older survivors, i.e. 21 (19.1%) vs 26 (22.6%) and 59 (53.6%) vs 63 (54.8%), respectively. One hundred ninety five survivors (86.7%) reported at least one comorbidity and 103 (45.8%) reported four or more comorbidities. The top three most prevalent comorbidities were: impaired vision (106, 47.1%), back pain (79, 35.1%), arthrosis/arthritis (76, 33.8%). The top ten most prevalent comorbidities for the overall population are depicted in Figure 1. Inspection of prevalence by age at diagnosis revealed a higher prevalence in the older survivors’ group with regard to some specific comorbidities. For example, younger survivors compared to older survivors reported a lower prevalence of hypertension (20.0% vs 41.7%), diabetes (8.2% vs 22.6%) and heart disease (1.8% vs 14.8%), respectively. Summary/Conclusion: Our findings indicate that long-term AML survivors have a substantial comorbidity burden even many years after diagnosis and may help to identify most pressing needs of these patients. Further analyses are needed to further elucidate the relationships between patient’s comorbidity and quality of life of AML survivors.Keywords: Comorbidities, Acute myeloid leukemia, Quality of life, Patient reported outcomes